Work Flow Management

Work Flow Management

 

Workflow management is how documents, information, and tasks are passed from one participant to another for an action to occur based on a set of procedural rules. It is the process and procedures in which tasks are completed. Work flow affects the processes such as a job is posted which then leads to the process of an employee being hired. Though there are numerous processes and communications in between, which if not completed appropriately may lead to inefficiency and inconsistency. The question management and leaders must ask is, are we operating as effectively and efficiently as possible? If no, that is when workflow management comes into action.

Unity’s Information Management

For the most part, Unity Hospital manages its information via technology and the EMR. Communication between the doctors, physician assistance, nurses, staff members, and patients can all occur via the electronic health record. There are some areas in the hospital which are still paper charting like the Family Birth Place, which does make communication between providers there more difficult. In all honesty, I believe that Unity does an excellent job for the most part with information management. With all things in life, there is always room for improvement.

                                                   Information Management Issue

An information management issue at Unity Hospital that I have recognized is that of the discharge instructions. Discharge instructions are completed by the physician’s assistant or resident once the patient has been seen by the attending or surgeon. Discharge instructions are completed by the PA or resident and then printed by the nurse and reviewed verbally with the patient.  The nurse as well as the patient have many other items on their mind at the time of discharge. The nurse is thinking about the patient who is not doing well down the hall, trying to answer the questions of family members, pass late medications, their next admission coming, as well as making sure this patient is discharged.

The patient is then handed a paper copy of the instructions. The paper copy has the ability to be lost in between the time it is handed to the patient, the patient packs his/her belongings, the patient leaves the room, enters his/her house, and then is relaxing. The patient may or may not recall specific instructions if they lose the paper copy such as important numbers to call, signs and symptoms to look for, their new medication list, as well as follow up appointments. These are the patients that typically are re-admitted through the ED within 30 days.

Is there a better way for the patient to be discharged? Can we electronically send the patient discharge instructions? Can we electronically send appointment reminders? Can we have the pharmacy call the patient when the medication they have been prescribed electronically is ready for pick up?

 

The Nurse as a Central Player

The nurse can be a cause of the issue, but also a solution to the workflow concern.

The concern: The nurse is busy with many legit concerns for his/her unit such as the dying patient down the hall, the patient who is non-compliant and refusing his/her insulin, the family members who keep calling to ask how their sick mother is, the doctor who needs to talk to you about the plan for room 7, all on top of the discharge the nurse just wants done so there is one less thing to do. But the nurse really doesn’t feel that way, the nurse wants the patient to understand the instructions, take their medications appropriately, and follow up with the Primary care physician as well as the attending or surgeon. The discharge instructions are often rushed and in terms that the patient may or may not understand. Chances are those papers will be dirty, thrown away, or misplaced by the time the patient is home and has the time to comprehend them.

The Solution: Sending a copy of the discharge instruction via email to the patient, helping the patient set up patient portal prior to discharge and having the discharge instructions linked to the portal, setting up phone call reminders to the patient about follow up appointments. Calling the pharmacy to send a reminder phone call when it is time to pick up their new medications.

Technology can be added or enhanced to add to the flow of discharge and allow the patient and nurse to feel more at ease during this difficult, time consuming process.

 

There are many links and articles that support the use of electronic discharge instructions as well as discharge follow ups. Below are a few of the articles and websites found:

Electronic Discharge Instructions on Post-Discharge Hospital Utilization

E-mail Follow Up Reminders

Improving Patient Understanding

Discharge Summary: Handwritten vs. Electronic Documentation